Current Research & Evaluations

In 2019, St Vincent’s Homeless Health Service launched a dedicated research program to evaluate the impact of its services on improving access to care for people experiencing homelessness.

CURRENT PROJECTS:

Project: Co-design of a Cooling Hub for People Experiencing Homelessness.

Team: Matthew Larkin, Alejandro Vasquez-Hernandez, Jo River, Jon Swain, Danielle Austin, Jane Currie and Timothy English.

Background: Heatwaves pose a significant public health risk, and people experiencing homelessness are particularly vulnerable to extreme heat and other climate change impacts while sleeping on the street, in vehicles, tents, or substandard housing. In a collaboration between St Vincent’s Hospital, the City of Sydney, University of Sydney, University of Technology and the Queensland University of Technology, we are co-designing and co-evaluating a mobile Cooling Hub to provide respite from extreme heat to those experiencing homelessness in the Sydney LGA. The Cooling Hub will be piloted during the summer of 2023/24 and evaluated using consumer satisfaction and comfort measures, incidence of heat related illness and impact of the Cooling Hub on heat related illness attendances to St Vincent’s Hospital Sydney.

Related publications:

• Heat Illness Requiring Emergency Care for People Experiencing Homelessness: A Case Study Series. Timothy English, Matthew Larkin, Alejandro Vasquez-Hernandez, Jennie Hutton, Jane Currie. https://doi.org/10.3390/ijerph192416565
• Scoping review of the characteristics and outcomes of adults presenting to the emergency department during heatwaves. Wendy Wu, Jennie Hutton, Rachael Zordan, Jamie Ranse, Julia Crilly, Naomi Tutticci, Timothy English, Jane Currie. https://doi.org/10.1111/1742-6723.14317

Media Links:

• https://theconversation.com/australias-first-mobile-cooling-hub-is-ready-for-searing-heat-this-summer-and-people-who-are-homeless-helped-design-it-218829?utm_source=linkedin&utm_medium=bylinelinkedinbutton
• How researchers designed Australia’s first mobile cooling hub - The University of Sydney
• Australia: People who are homeless designed a mobile cooling system | PreventionWeb
• Sydney free cooling hubs (timeout.com)

Project: Evaluating rehabilitation needs, access and service provision among people experiencing homelessness who have sustained a Traumatic Brain Injury (TBI)

Team: Christine Shiner, Simon Mosalski, Matthew Larkin, Valerie Bramah, Jane Currie, Karon McDonell, Steven Faux, Alejandro Vasquez-Hernandez and Fiona Haigh.

Background: People who experience homelessness are particularly vulnerable to problems with their physical and psychological health, and international research has identified that approximately half suffer a brain injury at some point in their life. In the broader population, rehabilitation is known to improve health outcomes and promote recovery following brain injury. However, it is not known whether routine rehabilitation services are accessible and adequately used by people who experience homelessness. This project aims to formally evaluate the accessibility and provision of rehabilitation for people experiencing homelessness who have sustained a TBI. We will explore how often those experiencing homelessness would benefit from rehabilitation; what they need from rehabilitation; whether they can access what they need, and/or whether there are certain barriers that prevent them from accessing current rehabilitation services.

For further info contact Dr Christine Shiner: christine.shiner@svha.org.au

Project: Access to Oral Health Services and Oral Health-Related Quality of Life in People Experiencing Homelessness

Team: Alejandro Vasquez-Hernandez, Matthew Larkin, Christine Shinner, and Andres Alonso Agudelo Suarez.

Background: People experiencing homelessness (PEH) often suffer from poorer oral health, with higher rates of untreated oral disease and more missing teeth than the general population, affecting their quality of life, daily activities, and mental health. This study aims to identify barriers and enablers to accessing oral health services for PEH in Sydney through focus groups with individuals with lived experience and healthcare professionals from St Vincent’s Homeless Health Service. A questionnaire will explore PEH's self-perception of oral health, habits, and service use, while the OHIP-14 will assess oral health-related quality of life (OHRQOL). Lastly, hospital data will be analysed to determine the prevalence and financial impact of oral health-related Emergency Department presentations over the past five years (2019–2023). Currently, the project is in the data collection stage, and we anticipate publishing the results in the first half of 2025.

Project: Identifying best practice patient experience and outcome measures in healthcare for people experiencing homelessness: a modified Delphi study

Team: Claire Doherty, Shannen Valessi, Jane Currie, Matthew Larkin, Jennie Hutton, Matthew Scott, Alejandro Vasquez-Hernandez and Lisa Wood.

Background: St Vincent’s Hospital Melbourne (SVHM) and St Vincent’s Hospital Sydney (SVHS) have programs focused on improving the health and wellbeing of people experiencing homelessness (PEH) with co-occurring health issues. This project aims to develop a patient experience survey tailored for PEH, capturing their subjective healthcare experiences. Given that PEH may have different expectations of care, adjusting patient experience measures to reflect their unique complexities is crucial for meaningful outcomes. The study will explore current measurement methods, identify challenges specific to PEH, and uncover unmet healthcare needs. Co-developing these measures with PEH is considered best practice. Ethics approval has been granted, and the project will begin in the first half of 2025.

Project: Enhancing patient voice across healthcare services for people experiencing homelessness.

Team: Claire Doherty, Matthew Larkin, Alejandro Vasquez-Hernandez, Matthew Scott, Jennie Hutton, Shannen Vallesi, Jane Currie and Lisa Wood.

Background: Compared to the general population, people experiencing homelessness (PEH) have poorer health outcomes and a lower life expectancy. Given the important association between patient experience and health outcomes, the need for the voice of PEH in patient experience data is crucial and, at present, is significantly under-represented. Quality improvement efforts will continue to be based on data that is not widely representative of those who experience the most significant disadvantage when attempting to access healthcare if this gap is not addressed. The aim of this research is to co-design a patient experience survey, including principles to guide implementation, specifically for PEH, which can be implemented across the continuum of healthcare services (acute, primary, telehealth). The project will begin in the first half of 2025.

Project: Pilot Implementation of the Homeless Health Response Bundle: A phase II hybrid randomised controlled trial.

Team: Jane Currie, Jennie Hutton, Claire Doherty, Andrew Chan, Lee Jones, Alejandro Vasquez-Hernandez, Hayley Pepper, Paisley Suggett and Jed Duff.

Background: To enhance healthcare access for people experiencing homelessness, we developed the Homeless Health Response Bundle—now called the Healthy & HomED model of care—for use in Emergency Departments and Specialist Homeless Services. This model includes the Homeless Health Access to Care Tool, which assesses health vulnerability (high, moderate, or low), and a Decision Assistance Guide to support shared decision-making in treatment planning. We tested the model in a phase II hybrid randomised controlled trial to evaluate its impact on 28-day reattendance rates at St Vincent’s Hospital Melbourne Emergency Department. Data collection concluded in September 2023, and we are preparing the manuscript for journal submission. We anticipate publishing the results in the first half of 2025.

Related publications:

• Development of the Homeless Health Access to Care Tool to identify health-related vulnerability among people experiencing homelessness: Delphi study, Australia. Jane Currie, Elizabeth Grech, Erin Longbottom, Jasmine Yee, Ruth Hastings, Amy Aitkenhead, Matthew Larkin, Lee Jones, Amy Cason, Karin Obrecht. https://doi.org/10.1136/bmjopen-2021-058893
• Multistage psychometric testing of the homeless health access to care tool. Jane Currie, Elizabeth Grech, Jasmine Yee, Amy Aitkenhead and Lee Jones. https://doi.org/10.3390/ijerph192315928
• Scoping review of the application of the Behavioural Model for Vulnerable Populations to people experiencing homelessness. Elizabeth Grech, Erin Longbottom, Jasmine Yee, Ruth Hastings, Amy Aitkenhead, Amy Cason, Karin Obrecht and Jane Currie. https://doi.org/10.1080/10530789.2022.2130590
• Scoping review of the characteristics assessed by vulnerability indices applied to people experiencing homelessness. Jane Currie, Elizabeth Grech, Erin Longbottom, Jasmine Yee, Ruth Hastings, Amy Aitkenhead, Amy Cason, Karin Obrecht. https://doi.org/10.1371/journal.pone.0254100

Project: Exploring health-related vulnerability among people attending the St Vincent’s Hospital Sydney Emergency Department.

Team: Jane Currie, Matthew Larkin, Alejandro Vasquez-Hernandez and Lee Jones.

Background: In this study we aimed to explore the connection between health-related vulnerability and the likelihood of re-attendance within 28-days at an emergency department within a 28-day period. Health-related vulnerability was measured using the Homeless Health Access to Care Tool (HHACT) – a 24 item scale developed by the Homeless Health Research Team.

In this study, the HHACT was administered to 300 participants (including those in stable and unstable housing) attending the Emergency Department of St Vincent’s Hospital Sydney over a 14-day period during regular business hours. Data collection concluded in October 2023, and we are currently in the process of preparing the manuscript for journal submission. We anticipate publishing the results in the first half of 2025.

Project: Optimising Scope of Practice of Nurses Providing Healthcare to People Experiencing Homelessness: Community Consultation.

Team: Jane Currie, Olivia Hollingdrake, Matthew Larkin, Alejandro Vasquez-Hernandez, Julie Gawthorne and Jo River.

Background: This project builds on a national survey of nurses caring for people experiencing homelessness, complemented by follow-up interviews with survey participants and a workforce capacity analysis. The primary aim of the community consultation is to explore the perspectives of people with lived experience to identify the optimal scope of nursing practice in homeless health care. Once gathered, these insights will be shared with nurses in homeless health services to gather their reflections on the proposed scope of practice. Data collection through interviews and focus groups concluded in June 2024, and we are currently preparing the manuscript for journal submission. We anticipate publishing the results in the first half of 2025.

Related publications:

• Optimising the Nursing Scope of Practice in a Homeless Health Service: A Qualitative Descriptive Study. Cristina Thompson, Darcy Morris, Matthew Larkin, Lucy McWilliams, Alejandro Vasquez-Hernandez, Jane Currie. https://doi.org/10.1111/jan.16633
• Staff Perceptions of the Potential for Nurses to Address Service Gaps Within a Homeless Health Service in Sydney, Australia: Results of a Cross-sectional Survey. Darcy Morris, Cristina Thompson, Alejandro Vasquez-Hernandez, Matthew Larkin, Lucy McWilliams, Jane Currie. https://doi.org/10.1016/j.colegn.2024.08.001
• Nurses’ perceptions of the skills, knowledge and attributes required to optimise scope of practice and improve access to care for people experiencing homelessness in Australia: A cross sectional study.Jane Currie, Lucy McWilliams, Martha Paisi, Jill Shawe, Anna Thornton, Matthew Larkin, Joanne Taylor, Sandy Middleton. https://doi.org/10.1016/j.colegn.2023.02.002
• Nurses’ perceptions on the skills, knowledge and attributes required to provide healthcare to people experiencing homelessness in Australia: A qualitative study. Jane Currie, Lucy McWilliams, Vijeta Venkataraman, Martha Paisi, Jill Shawe, Anna Thornton, Matthew Larkin, Joanne Taylor, Sandy Middleton. https://doi.org/10.1016/j.colegn.2023.03.006
• Scoping review: Scope of practice of nurse-led services and access to care for people experiencing homelessness. Lucy McWilliams, Martha Paisi, Sandy Middleton, Jill Shawe, Anna Thornton, Matthew Larkin, Joanne Taylor, Jane Currie. https://doi.org/10.1111/jan.15387

OTHER PUBLICATIONS:

• Critical Success Factors for Intersectoral Collaboration: Homelessness and COVID-19 – Case Studies and Learnings from an Australian City:Stephanie Macfarlane, Fiona Haigh, Lisa Woodland, Brendan Goodger, Matthew Larkin, Erin Miller, Lisa Parcsi, Phillip Read, Lisa Wood. This paper reports on an intersectoral response to the COVID-19 pandemic in the geographical area and surrounding suburbs of Inner Sydney, NSW, Australia, in which homelessness is highly concentrated, accounting for a third of people sleeping rough in NSW. https://doi.org/10.5334/ijic.7653
• Optimising Access to the COVID-19 Vaccination for People Experiencing Homelessness: Jane Currie, Olivia Hollingdrake, Elizabeth Grech, Georgia McEnroe, Lucy McWilliams, and Dominic Le Lievre. This study assessed the Inner City COVID-19 Vaccine Hub in Sydney, which provided 4,305 vaccinations and improved access for people experiencing homelessness. Findings informed a blueprint to guide similar efforts for vulnerable populations. https://doi.org/10.3390/ijerph192315686
• Blueprint model of care to support vaccine hubs for people experiencing homelessness: The purpose of this document is to offer guidance to other agencies in the development and delivery of vaccine hubs for people experiencing or at risk of homelessness. The model of care described here is also relevant to vaccination efforts targeting other hard to reach or marginalised people and communities. https://apo.org.au/node/314543

For additional information about any of the projects, please contact Alejandro Vasquez-Hernandez at alejandro.vasquez@svha.org.au